Mental-Health Coverage in the New Reform Plan Second-Class Status Would Be a Mistake

DANIEL S. GREENBERG

June 08, 1993|By DANIEL S. GREENBERG

WASHINGTON — Washington.--Reports that the Clinton health reformers plan to skimp on mental-health services should be filed under an ancient and disrespectful heading: How crazy can you get?

Statistics show that Americans are actually getting healthier and living longer, but they also show that mental disturbance is on the upswing. The roster of disorders ranges from teen-age suicide to geriatric alcoholism, with depression, schizophrenia and a host of other mental ailments included, too.

This is no time to cave in to know-nothing prejudices that minimize the pain and destructiveness of mental illness and the importance and effectiveness of psychological treatments. As many people sadly know, a serious psychological problem is as real as a broken leg or an inflamed appendix, and like those afflictions, requires professional treatment.

The health-insurance plan that the White House says it will submit to Congress this month is now being put in final form. But from many quarters come reports that, for reasons of economy, coverage of mental-health services will be limited in terms of duration of treatment. Full coverage, however, will be provided for physical disorders. The two-tier arrangement may make sense to economists, but it is totally lacking in medical sense.

The statistics of mental illness are downright depressing. Suicide, for example, is the eighth leading cause of death for all ages in the United States. But among teen-agers, it's listed as the second leading cause, just behind auto accidents -- a deadly phenomenon that frequently involves mental disturbance induced by alcohol or drugs. The National Vital Statistics System reports that among persons 15-24, suicides per 100,000 soared from 4.5 in 1950 to 13.3 in 1989.

Back in the dark ages of public understanding of mental illness, depression was viewed as simply a lack of cheerfulness which the victim could correct by adopting a sunny outlook. The futility of this approach was apparent, but unfortunately endured until public education programs sponsored by mental-health organizations made it plain that depression is a serious illness that rarely ever responds to amateur good will.

It is also a highly prevalent disorder. According to the Department of Health and Human Services, ''numerous studies have shown that at any one time between 9 percent and 20 percent of the U.S. population have depressive symptoms.'' The incidence of major depressive episodes is fortunately lower -- 2.3 to 4.4 percent for men; 4.9 to 8.7 percent for women. But those percentages add up to many millions of people -- all afflicted with a mental disorder that is severely disabling and quite often fatal through suicide.

The tendency to relegate mental patients to second-class status in a national health system reflects old biases and animosities toward psychological problems. In 1972, Sen. Thomas Eagleton was forced to resign as the Democratic vice-presi- dential candidate when it became publicly known that he had undergone treatment for depression. The message of that episode was that it is better to go untreated than risk exposure as someone who had the need and good sense to seek psychiatric assistance.

In the 1988 presidential election, Republican dirty tricksters tried to make hay out of the fact that Democratic candidate Michael Dukakis had once undergone psychological counseling. Mr. Dukakis fended off the charge with the explanation that he had sought help in a matter of family bereavement. These episodes of political exploitation certify that mental illness is still regarded, at least in some quarters, as a taint on character rather than a treatable misfortune.

Consigning mental health to second-class status in a national health plan would be a misjudgment in any circumstances. But the folly is compounded by the fact that psychiatric medicine appears to be on the brink of a golden age of new drugs that effectively and inexpensively treat previously intractable mental disorders. Real economies occur when patients are able to return to work and personal responsibilities. Great costs are incurred when they don't.

Of course, the president, Mrs. Clinton and their health planners understand this. That's why there's hope that they won't reach for the small savings and undercut one of the most critical elements in any system of health care.

Daniel S. Greenberg is a syndicated columnist specializing in the politics of science and health.